Youth Section: Dangers of Smoking, Penile Erection Pain, and Mumps and Orchitis

**34. What are the harmful effects of smoking on male reproductive health?**

A healthy adult male has 60 million to 150 million sperm per milliliter of semen, with a motility rate greater than 85% and less than 20% abnormal sperm. When the sperm count is too low, the motility rate is low, or there are many abnormal sperm, it can lead to a decline in male reproductive function and even infertility.

Smoking reduces sperm count, motility, and the incidence of abnormal sperm. Tobacco contains nicotine, which acts on the seminiferous epithelium of the seminiferous tubules, impairing spermatogenesis and resulting in fewer and lower-quality sperm. Clinical studies in Australia have found that smokers have an average of 27 million sperm per milliliter of semen, with a motility rate of 49.27%. Among those who smoke more than 20 cigarettes a day, 6% have only 1 million sperm per milliliter of semen, significantly lower than the basic number required for fertilization, leading to infertility. Furthermore, smokers are 10 times more likely to develop varicocele than non-smokers, which further reduces sperm count and motility, contributing to infertility.

Another fatal harm of smoking to men is that it can cause erectile dysfunction. Studies have confirmed that long-term smokers can cause blockages in small blood vessels at the extremities, including those in the penis, leading to poor blood supply to the penis and resulting in impotence. Impotence prevents couples from having normal sexual intercourse, causing not only infertility but also affecting marital relationships, family life, and harmony.

35. Why does the penis hurt during erection?

The most common cause of painful erections is infection of the male genital tract. In some cases, phimosis can also cause painful erections because the glans penis is significantly compressed during erection, resulting in pain. Additionally, some men experience painful erections due to injury to the penis caused by overly vigorous masturbation or sexual intercourse.

The penis consists of two corpora cavernosa and one corpus spongiosum, and it serves both urination and ejaculation functions. Painful erection can be categorized into the following types:

(1) Phimosis and adhesions. When the penis is erect, it is painful to retract the foreskin, and in severe cases it can even cause paraphimosis.

(2) Penile deformities can also cause pain during penile erection.

(3) Penile inflammation and trauma. Balanitis, urethritis, and urethral stricture can all cause painful penile erection in men.

(4) Excessive sexual activity can also cause penile erection pain.

**36. Can mumps lead to orchitis?**

The mumps virus not only affects the parotid glands but also frequently acts on nerve tissue and the pancreas, and has a considerable affinity for the testes. Orchitis occurs in 1/5 to 1/4 of mumps patients, with 2/3 being unilateral and 1/3 bilateral. The illness lasts 3-5 days, but in severe cases can last up to 2 weeks. Orchitis occurring after puberty can cause irreparable damage to the epithelial and interstitial cells of the seminiferous tubules of the testes, potentially leading to testicular atrophy. Furthermore, bilateral mumps-orchitis in adult men can cause hypogonadism, sometimes simultaneously resulting in azoospermia or a severely reduced sperm count (below 4 million/mL).

Diagnosing orchitis is not difficult. Testicular pain is often severe tenderness, accompanied by swelling of one or both testes. Symptoms and signs of mumps often precede or occur simultaneously with testicular swelling and pain. Sometimes only one side presents with signs, but this does not mean the other testis is unaffected; long-term follow-up reveals that even if only one side is affected, the other side will also show degenerative changes. Uneven testicular texture and irregular shape found during physical examination often indicate the presence of scarring. About half of patients with bilateral orchitis have mild testicular atrophy. Atrophy in one testis has less impact on fertility and does not affect sexual life after marriage; however, if both testes are affected, it can lead to infertility. Even without a significant decrease in testicular size, atrophy of the seminiferous tubules can still occur, severely impacting fertility. In severe cases of testicular atrophy, the volume can decrease to about 5 ml. When testicular cell structure is damaged, not only are the spermatogenic epithelial cells affected, but the interstitial cells are also involved. In severe cases, testicular biopsy can confirm "Serpentine cell-only syndrome," meaning that no spermatogenic cells are present in the seminiferous tubules. The fertility of these patients is essentially hopeless, yet some still blindly seek treatment everywhere, wasting countless hours and energy.

In some patients, progressive fibrosis of the testes may persist for several years after the onset of the disease. These patients may still produce sperm, and the sperm count may be within the normal range, but the sperm survival rate is often only about 30%, the motility is significantly reduced, and fertility is poor.